Membership Types

New Member

Renewal

Pharmacist (2 Years)

$130

Pharmacist (1 Year)

$75

Supporting Associate

$75

Retired Pharmacist

$50

Technician

$45

Resident/Flow

$45

Student

$10

What is your practice setting?

Community Hospital

University Hospital

Government Hospital

Integrated Health System

HMO

Pharmacy Benefit Mgt Firm

Home Care

Nursing Home/SubAcute/Long-Term Facility

College/University

Industry

Retail

Government Agency

Which type of patients are the primary focus of your practice?

Ambulatory

Acute Care

Home Care

Long-Term Care

Are you a current ASHP member?

Yes

No

Committee Involvement:

I am interested in working on the following committee:

Finance

Membership

Nominations

Legislative

Programming (monthly meetings)

Publications (newsletters, website)

Personal Details:

Name:

Institution:

Position:

Address:

Office Home

Phone:

Fax:

Email: